Uptake of HIV testing and outcomes within a Community-based Therapeutic Care (CTC) programme to treat Severe Acute Malnutrition in Malawi: a descriptive study

<p>Abstract</p> <p>Background</p> <p>In Malawi and other high HIV prevalence countries, studies suggest that more than 30% of all severely malnourished children admitted to inpatient nutrition rehabilitation units are HIV-infected. However, clinical algorithms designed to diagnose paediatric HIV are neither sensitive nor specific in severely malnourished children. The present study was conducted to assess : i) whether HIV testing can be integrated into Community-based Therapeutic Care (CTC); ii) to determine if CTC can improve the identification of HIV infected children; and iii) to assess the impact of CTC programmes on the rehabilitation of HIV-infected children with Severe Acute Malnutrition (SAM).</p> <p>Methods</p> <p>This community-based cohort study was conducted in Dowa District, Central Malawi, a rural area 50 km from the capital, Lilongwe. Caregivers and children admitted in the Dowa CTC programme were prospectively (Prospective Cohort = PC) and retrospectively (Retrospective Cohort = RC) admitted into the study and offered HIV testing and counseling. Basic medical care and community nutrition rehabilitation was provided for children with SAM. The outcomes of interest were uptake of HIV testing, and recovery, relapse, and growth rates of HIV-positive and uninfected children in the CTC programme. Student's t-test and analysis of variance were used to compare means and Kruskall Wallis tests were used to compare medians. Dichotomous variables were compared using Chi²analyses and Fisher's exact test. Stepwise logistic regression with backward elimination was used to identify predictors of HIV infection (α = 0.05).</p> <p>Results</p> <p>1273 and 735 children were enrolled in the RC and PC. For the RC, the average age (SD) at CTC admission was 30.0 (17.2) months. For the PC, the average age at admission was 26.5 (13.7) months. Overall uptake of HIV testing was 60.7% for parents and 94% for children. HIV prevalence in severely malnourished children was 3%, much lower than anticipated. 59% of HIV-positive and 83% of HIV-negative children achieved discharge Weight-For-Height (WFH) ≥ 80% of the NCHS reference median (p = 0.003). Clinical algorithms for diagnosing HIV in SAM children had poor sensitivity and specificity.</p> <p>Conclusion</p> <p>CTC is a potentially valuable entry point for providing HIV testing and care in the community to HIV infected children with SAM.</p

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Preliminary Assessment of Bovine Tuberculosis at the Livestock/Wildlife Interface in two Protected Areas of Northern Botswana

Protected areas of northern Botswana such as the Okavango Delta (OD) or Chobe National Park (CNP) are well-known hot spots for the conservation of African wildlife. However, their infection status regarding bovine tuberculosis (BTB) at the domestic/wildlife interface has never been investigated. To provide preliminary baseline data on the circulation of Mycobacterium bovis in those sites, we performed a cross-sectional survey on 130 buffalo in both protected areas (60 individuals from CNP and 70 from OD) and 818 cattle in their surrounding communal lands (369 in CNP and 449 in the OD). Whole-blood samples were tested using a commercial interferon-gamma assay (IFN-c) with modifications. The apparent BTB prevalence in buffalo was nil in CNP and 0.7% 95% CI [0.2–1.9] in the OD, while the apparent BTB prevalence in cattle was 0.7% 95% CI [0.2–2.1] in the OD and 2.4% 95% CI [1.2–4.7] in CNP. True prevalence values calculated on the basis of the locally applicable IFN-c test performance suggested that BTB prevalence was nil in both buffalo populations and in cattle from the OD interface, but reached 2.3% 95% CI [0.2–4.5] in cattle populations around CNP. The results of a questionnaire survey conducted among a sample of farmers living in the communities adjacent to each conservation area (97 and 38 persons in the OD and CNP, respectively) suggested a higher risk of the circulation of M. bovis at the wildlife/livestock interface of the CNP than at that of the OD. However, further comprehensive studies are needed to confirm the circulation of M. bovis and to monitor the inter-species and transboundary transmission of BTB in northern Botswana.The Food and Agriculture Organization, EMPRES Animal Health Unit and the Wildlife Health and Ecology Unit.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1865-1682hb201